Healthcare Provider Details

I. General information

NPI: 1447843198
Provider Name (Legal Business Name): KATHERINE L KILBURN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2021
Last Update Date: 02/13/2021
Certification Date: 02/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4933 STRAIGHT FRK
YAWKEY WV
25573-9635
US

IV. Provider business mailing address

4933 STRAIGHT FRK
YAWKEY WV
25573-9635
US

V. Phone/Fax

Practice location:
  • Phone: 304-524-7869
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: